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SOUTH BEND MEDICAL FOUNDATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SOUTH BEND MEDICAL FOUNDATION INC (EIN 35-0868178)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-15
IRS object ID
201213209349303566
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-15T11:01:50-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CROWE HORWATH LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1330 E Jefferson BlvdAddressLine1
Address Line2PO Box 7AddressLine2
CitySouth BendCity
StateINState
ZIP Code466240007ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN350868178EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SOUTH BEND MEDICAL FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSOUTNameControl
Phone5742045291Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1530 North Lafayette BlvdAddressLine1
CitySouth BendCity
StateINState
ZIP Code46601ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameROBERT TOMEC MDName
TitlePRESIDENT/EXECUTIVE VPTitle
Date Signed2012-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKENNETH J KEBERName
PTINP00240883PTIN
Phone5742323992Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

FieldValueIRS element (for citing)
Business Name Line1ROBERT TOMEC MDBusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1530 North Lafayette BlvdAddressLine1
CitySouth BendCity
StateINState
ZIP Code46601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts97754310GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SBMF.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1946YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionSOUTH BEND MEDICAL FOUNDATION EXISTS FOR THE PURPOSE OF PROVIDING QUALITY AND COST EFFECTIVE LABORATORY AND BLOOD BANKING SERVICES TO HOSPITALS, PHYSICIANS, AND PATIENTS.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees839TotalNbrEmployees
Total Nbr Volunteers13TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year94079057ProgramServiceRevenuePriorYear
Program Service Revenue CY97034819ProgramServiceRevenueCY
Investment Income Prior Year-56147InvestmentIncomePriorYear
Investment Income Current Year80602InvestmentIncomeCurrentYear
Other Revenue Prior Year533715OtherRevenuePriorYear
Other Revenue Current Year585608OtherRevenueCurrentYear
Total Revenue Prior Year94556625TotalRevenuePriorYear
Total Revenue Current Year97701029TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2374760GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year46325689SalariesEtcPriorYear
Salaries Etc Current Year46509524SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year47747382OtherExpensePriorYear
Other Expenses Current Year46468237OtherExpensesCurrentYear
Total Expenses Prior Year94073071TotalExpensesPriorYear
Total Expenses Current Year95352521TotalExpensesCurrentYear
Revenues Less Expenses Prior Year483554RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2348508RevenuesLessExpensesCY
Total Assets BOY53079665TotalAssetsBOY
Total Assets EOY53629071TotalAssetsEOY
Total Liabilities BOY36874699TotalLiabilitiesBOY
Total Liabilities EOY46010216TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY16204966NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7618855NetAssetsOrFundBalancesEOY
Mission DescriptionSOUTH BEND MEDICAL FOUNDATION EXISTS FOR THE PURPOSE OF PROVIDING QUALITY AND COST EFFECTIVE LABORATORY AND BLOOD BANKING SERVICES TO HOSPITALS, PHYSICIANS, AND PATIENTS. (CONTINUED IN SCHEDULE O).MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense79333517Expense
Grants2374760Grants
Revenue97450509Revenue
DescriptionSOUTH BEND MEDICAL FOUNDATION'S (SBMF) MORE THAN 750 EMPLOYEES PROVIDE A WIDE RANGE OF TOP-QUALITY, COST-EFFECTIVE HEALTH CARE SERVICES FOR COMMUNITIES IN INDIANA, MICHIGAN, KENTUCKY, OHIO, AND ILLINOIS. BY WORKING TOGETHER WITH LOCAL HEALTH CARE PROVIDERS, SBMF PRESERVES THE CRITICAL RELATIONSHIP BETWEEN LABORATORY, PHYSICIAN AND PATIENT. UNLIKE MANY LARGE COMMERCIAL LABORATORIES, SBMF OFFERS ITS SERVICES 24 HOURS A DAY, 365 DAYS A YEAR. SBMF PERSONNEL ARE DEDICATED TO BEING A TRUSTED PHYSICIAN RESOURCE, HANDLING EVERYTHING FROM ROUTINE OUTPATIENT ORDERS TO PROVIDING INPATIENT SERVICES AT HOSPITAL AND OTHER HEALTH CARE FACILITIES THROUGHOUT THE REGION. SBMF'S COMMITMENT TO DELIVERING CONSISTENT, RELIABLE, QUALITY MEDICAL CARE HAS PLAYED AN INSTRUMENTAL ROLE IN HELPING THE FOUNDATION ACHIEVE ITS POSITION OF LEADERSHIP AMONG THE NATION'S DIAGNOSTIC LABORATORIES. THE ALTRUISTIC ACTIVITIES OF THE ORGANIZATION ARE INTENDED TO RELIEVE DISEASE, SUFFERING, AND CONSTRAINT. MANY SERVICES ARE PROVIDED AS CHARITY OR PRO BONO. THE AMOUNT OF CHARITY CARE, PROVIDED AT SBMF'S ESTABLISHED RATES, WAS APPROXIMATELY $775,500 FOR THE YEAR ENDED DECEMBER 31, 2011.Description
Total Program Service Expense79333517TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109678NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees839NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1James B MyersBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5742045206TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1118 W Edison RoadAddressLine1
CityMishawakaCity
StateINState
ZIP Code46545ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (43 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
MICHELLE A MIGLIORE DO
CHAIRMAN1.00XX000
STEPHEN F MITROS MD
VICE CHAIRMAN1.00XX000
ALAN B ENGEL MD
BOARD MEMBER1.00X000
BARBARA L WILLIAMS MD
BOARD MEMBER1.00X000
BILAL ANSARI MD
BOARD MEMBER1.00X000
BRIAN SUCHARETZA MD
BOARD MEMBER1.00X000
CHARLES E PETERSON MD
BOARD MEMBER1.00X000
DAVID E VAN RYN MD
BOARD MEMBER - PARTIAL YEAR1.00X000
FREDERICK J FERLIC MD
BOARD MEMBER1.00X000
JOHN T RICE MD
BOARD MEMBER1.00X000
JOSE A BUFILL MD
BOARD MEMBER - PARTIAL YEAR1.00X000
KURT H STIVER MD
BOARD MEMBER1.00X000
STARLA D GRABER MD
BOARD MEMBER1.00X000
ANN SULLIVAN
VP OF FINANCE40.00X228760037920
DIANE JANOWIAK
VP OF CENTRAL LAB OPERATIONS40.00X228094026960
JAMES FRAIN
VP OF HUMAN RESOURCES40.00X227788038074
ROBERT KING
SENIOR VP40.00X260760028631
ROBERT TOMEC MD
PRESIDENT/EXECUTIVE VP40.00X389140028984
WILLIAM KALINEY MD
VICE PRESIDENT/EXECUTIVE VP40.00X388097029926
ALFONSO CARDENAS MD
PATHOLOGIST40.00365598028907X
AMOBI EZENEKWE MD
PATHOLOGIST40.00241609040199X
BLAIR CHRENKA MD
PATHOLOGIST40.00233852035904X
BOBBIE SUTTON MD
PATHOLOGIST40.00275715024422X
C K KIM MD
PATHOLOGIST40.00366231031858X
DAVID JENTZ MD
PATHOLOGIST40.00366799028266X
DERRICK FORCHETTI MD
PATHOLOGIST40.00257422032004X
FRANCISCO DEOGRACIAS MD
PATHOLOGIST40.00355512028656X
FRED BUSSE MD
PATHOLOGIST40.00250011028204X
JAMES DYER MD
PATHOLOGIST40.00240679014902X
JOHN LANDGRAF MD
PATHOLOGIST40.00251376025703X
JOSEPH PRAHLOW MD
PATHOLOGIST40.00269119034429X
JOYCE SIMPSON MD
PATHOLOGIST40.00264602016902X
KRISTEN JACOBS MD
PATHOLOGIST40.00217148033370X
LUIS GALUP MD
PATHOLOGIST40.00368903040969X
NICOLE ANEST MD
PATHOLOGIST40.00222963027858X
NITA GERIG MD
PATHOLOGIST40.00287105037825X
ODETA LAPKUS MD
PATHOLOGIST40.00246896029650X
RICKY HOOVER MD
PATHOLOGIST40.00349916038187X
CARRIE ROBINSON
REGIONAL MARKETING DIRECTOR40.00111340030963X
DEBORAH SUN
DIRECTOR - NEW TECHNOLOGY AND TEST DEVELOPMENT40.00173146031602X
JANET AGLER
REGIONAL MARKETING MANAGER40.00123342026144X
KAY BEAM
DIRECTOR, INFORMATION TECHNOLOGY, DATABASE MANAGEMENT40.0010323604266X
PRENTISS JONES
DIRECTOR - TOXICOLOGY40.00146909022101X
FieldValueIRS element (for citing)
Total Reportable Comp From Org7812068TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation883786TotalOtherCompensation
Number Individuals GT100 K31NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ASSOC REG AND UNIV PATHOLOGISTS
PO BOX 27964SALT LAKE CITYUT84127REFERENCE LAB2268569
THERMO ASSET MANAGEMENT SERVICES INC
PO BOX 712224CINCINNATIOH452712224EQUIPMENT MAINTENANCE / REPAIR922486
MICHIANA HEALTH INFORMATION NETWORK
220 W COLFAX AVENUE SUITE 300SOUH BENDIN46601COMMUNITY BASED CLINICAL INFO SYSTEM745630
CERNER CORPORATION
PO BOX 412702KANSA CITYMO641172551EQUIPMENT MAINTENANCE / REPAIR545169
PARKVIEW PROFESSIONAL PROGRAMS
PO BOX 2504FORT WAYNEIN46801REFERENCE LAB457370
FieldValueIRS element (for citing)
Number Of Contractors GT100 K17NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET OPERATING REVENUESDescription
Business Code621500BusinessCode
Total Revenue Column97034819TotalRevenueColumn
Related Or Exempt Function Income97034819RelatedOrExemptFunctionIncome

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue97034819TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column60573TotalRevenueColumn
Exclusion$60,573ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other73310Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other53281Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities
Other20029Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column20029TotalRevenueColumn
Exclusion$20,029ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
CLINICAL PATHOLOGY FEES621500415690415690
MISCELLANEOUS90009993511$93,511
TEACHING FEES61143076407$76,407

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue585608TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column97701029TotalRevenueColumn
Related Or Exempt Function Income97450509RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$250,520ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total72724Total
Program Services72724ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total2302036Total
Program Services2302036ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total7754243Total
Program Services6297881ProgramServices
Management And General1456362ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total27205200Total
Program Services21784125ProgramServices
Management And General5421075ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total841497Total
Program Services673787ProgramServices
Management And General167710ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total8471302Total
Program Services6782972ProgramServices
Management And General1688330ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2237282Total
Program Services1794327ProgramServices
Management And General442955ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total68159Total
Management And General68159ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total88034Total
Management And General88034ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total750Total
Management And General750ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1560005Total
Program Services933181ProgramServices
Management And General626824ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3058640Total
Program Services1539564ProgramServices
Management And General1519076ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1900103Total
Program Services1878106ProgramServices
Management And General21997ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total805352Total
Program Services691889ProgramServices
Management And General113463ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total816738Total
Program Services23126ProgramServices
Management And General793612ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3750180Total
Program Services3288526ProgramServices
Management And General461654ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total788208Total
Management And General788208ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL LAB2092984220129064800778
REFERENCE LAB43216084321608
BAD DEBT40133624013362
BUILDING EQUIPMENT/MAINTENANCE346533320664711398862

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total901923Total
Program Services740768ProgramServices
Management And General161155ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total95352521Total
Program Services79333517ProgramServices
Management And General16019004ManagementAndGeneral
Fundraising0Fundraising

Total Joint Costs TotalJointCosts

FieldValueIRS element (for citing)
Total0Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY855BOY
EOY850EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY9062803BOY
EOY11644739EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY11333965BOY
EOY11361378EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1439582BOY
EOY1756111EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1188618BOY
EOY1240012EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis93017482LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec66037295LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY29381047BOY
EOY26980187EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY480611BOY
EOY490286EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY192184BOY
EOY155508EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY53079665BOY
EOY53629071EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY8185225BOY
EOY8208104EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY12445000BOY
EOY11565000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY16244474BOY
EOY26237112EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY36874699BOY
EOY46010216EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY16204966BOY
EOY7618855EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY16204966BOY
EOY7618855EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY53079665BOY
EOY53629071EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2348508ReconcilationRevenueExpenses
Reconcilation Other Changes-10934619ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Total0Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years94299025CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years92391025CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years94545973CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year94079057CurrentTaxYearMinus1Year
Current Tax Year97034819CurrentTaxYear
Total472349899Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years193765CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years238981CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year195040CurrentTaxYearMinus1Year
Current Tax Year169918CurrentTaxYear
Total797704Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years94299025CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years92584790CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years94784954CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year94274097CurrentTaxYearMinus1Year
Current Tax Year97204737CurrentTaxYear
Total473147603Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total
FieldValueIRS element (for citing)
Public Support Total509473147603PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years844996CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years60887CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years-108281CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year-69086CurrentTaxYearMinus1Year
Current Tax Year60573CurrentTaxYear
Total789089Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years844996CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years60887CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years-108281CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year-69086CurrentTaxYearMinus1Year
Current Tax Year60573CurrentTaxYear
Total789089Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years496466CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years353784CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years334004CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year338675CurrentTaxYearMinus1Year
Current Tax Year415690CurrentTaxYear
Total1938619Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years95640487CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years92999461CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years95010677CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year94543686CurrentTaxYearMinus1Year
Current Tax Year97681000CurrentTaxYear
Total475875311Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99430PublicSupportPercentage509
Prior Year Support Percentage0.99380PriorYearSupportPercentage
Investment Income Percentage0.00170InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00190PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationOTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - CLINICAL PATHOLOGY FEES, COLUMN A - 496466, COLUMN B - 353784, COLUMN C - 334004, COLUMN D - 338675, COLUMN E - 415690, COLUMN F - 1938619;,GeneralExplanation

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationstrueGrantsOtherOrganizations
Grants Other Organizations$750GrantsOtherOrganizationsAmount
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB750TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierDescription of the activities reported on Lines 1a through 1iIdentifier
Return ReferenceSchedule C, Part II-B, Line 1ReturnReference
ExplanationLINE 1F: DURING 2011, SOUTH BEND MEDICAL FOUNDATION PAID $750 TO THE INDIANA ASSOCIATION OF PATHOLOGISTS (IAP) FOR LOBBYING EFFORTS IN SUPPORT OF DIRECT BILLING LEGISLATION FOR ANATOMIC PATHOLOGY SERVICES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis982468OtherCostOrOtherBasis
Book Value982468BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis46775322OtherCostOrOtherBasis
Depreciation25409131Depreciation
Book Value21366191BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis912078OtherCostOrOtherBasis
Depreciation417469Depreciation
Book Value494609BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis44334114OtherCostOrOtherBasis
Depreciation40210695Depreciation
Book Value4123419BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis13500OtherCostOrOtherBasis
Book Value13500BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings26980187TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
ACCRUED PENSION AND POSTRETIREMENT BENEFITS$23,698,207
FAIR VALUE OF INTEREST RATE SWAP$2,339,046
CAPITAL LEASE OBLIGATION$199,859
FieldValueIRS element (for citing)
Total Of Amounts26237112TotalOfAmounts
Total Revenue97701029TotalRevenue
Total Expenses95352521TotalExpenses
Excess Or Deficit For Year2348508ExcessOrDeficitForYear
Net Unrealized GL On Investments-97912NetUnrealizedGLOnInvestments
Other-$10,836,707OtherAmount
Total Adjustments-10934619TotalAdjustments
Excess Or Deficit Per FS-8586111ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt80493173TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-97912NetUnrealizedGainsInvestments
Other Revenues0OtherRevenues
Revenue Not Rptd F990-97912RevenueNotRptdF990
Revenue Subtotal80591085RevenueSubtotal
Other Revenues Not Included17109944OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt17109944RevenueNotRptdOnFinStmt
Total Revenue Per Form99097701029TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt89079284TotExpensesEtcAuditedFinclStmt
Other Expenses Included0OtherExpensesIncluded
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal89079284ExpensesSubtotal
Other Expenses Not Included6273237OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt6273237ExpensesNotRptdOnFinStmt
Total Expenses Per Form99095352521TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierFIN 48 (ASC 740) footnoteIdentifier
Return ReferenceSchedule D, Part X, Line 2ReturnReference
ExplanationTHE FOUNDATION IS A NOT-FOR-PROFIT ORGANIZATION PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES PURSUANT TO SECTION 501(A). ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS REFLECTED IN THE FOUNDATION'S FINANCIAL STATEMENTS. THE FOUNDATION IS SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES FOR THE YEARS ENDED DECEMBER 31, 2008 THROUGH 2011. THE FOUNDATION FOLLOWS GUIDANCE ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD WITH RESPECT TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. A TAX POSITION IS A BENEFIT ONLY IF IT IS "MORE LIKELY THAN NOT" THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE "MORE LIKELY THAN NOT" TEST, NO TAX BENEFIT IS RECORDED. MANAGEMENT HAS DETERMINED THAT THERE IS NO LIABILITY FOR UNCERTAIN TAX POSITIONS AND DOES NOT EXPECT THIS TO CHANGE OVER THE NEXT TWELVE MONTHS.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1Address Line2AddressUS/AddressLine2CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistancePurpose Of GrantPurposeOfGrant
ECONOMIC DEVELOPMENT CORPORATION OF ELKHART COUNTY
102 W LINCOLN AVEROOM/SUITE 210GOSHENIN46526351973845501(C)(3)60000N/AN/AGENERAL PROGRAM SUPPORT
INDIANA UNIVERSITY FOUNDATION
PO BOX 500BLOOMINGTONIN47204356018940501(C)(3)50000N/AN/ASUPPORT IU SCHOOL OF MEDICINE-SOUTH BEND
MARCH OF DIMES - INDIANA CHAPTER
136 EAST MARKET STREETSUITE 500INDIANAPOLISIN46204131846366501(C)(3)50000N/AN/AGENERAL PROGRAM SUPPORT
THE FOUNDATION OF ST JOSEPH REGIONAL MEDICAL CENTER
837 EAST CEDAR STREET NO 350SOUTH BENDIN466172069351654543501(C)(3)93200N/AN/AGENERAL PROGRAM SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants4TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)

Type Of GrantTypeOfGrantAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
PATIENT MEDICAL ASSISTANCE01762621BOOK VALUEFREE OR REDUCED MEDICAL CARE
TIME OF SERVICE DISCOUNTS0539415BOOK VALUEDISCOUNT PROVIDED AT TIME OF PAYMENT

Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Procedures for monitoring use of grant fundsSchedule I, Part I, Line 2SOUTH BEND MEDICAL FOUNDATION (SBMF) PROVIDES FUNDING TO OTHER COMMUNITY NOT-FOR-PROFIT ORGANIZATIONS. GENERALLY, THESE ARE UNRESTRICTED CONTRIBUTIONS THAT THE RECEIVING ORGANIZATION CAN USE TO FURTHER THEIR MISSION AND PROGRAMS AT THEIR DISCRETION. THE USE OF THESE CONTRIBUTIONS IS NOT MONITORED. SBMF ALSO PROVIDES ASSISTANCE TO INDIVIDUALS IN THE FORM OF FREE OR REDUCED FEE MEDICAL CARE AT VARIOUS LOCATIONS THROUGHOUT THE COMMUNITIES SERVED. THESE INDIVIDUALS MEET SBMF'S CHARITY CARE ELIGIBILITY REQUIREMENTS, OR THE REQUIREMENTS OF THE REFERRING HEALTH CARE PROVIDER. DETERMINATION AND MONITORING OF CHARITY CARE IS PERFORMED ON A CASE-BY-CASE BASIS. SBMF ALSO PROVIDES DISCOUNTS FOR PAYMENT AT TIME OF SERVICE TO PATIENTS WHO DO NOT HAVE GOVERNMENT PROVIDED INSURANCE COVERAGE OR DO NOT WISH TO HAVE A CLAIM FILED WITH THEIR COMMERCIAL INSURANCE CARRIER. THERE IS NO ACTUAL EXCHANGE OF FUNDS, AS THE DISCOUNTS ARE CREDITED DIRECTLY TO THE PATIENTS' ACCOUNTS. TIME OF SERVICE DISCOUNTS ARE MONITORED AT THE ORGANIZATION LEVEL, IN THE AGGREGATE.
NUMBER OF RECIPIENTSSCHEDULE I, PART III, COLUMN (B)CURRENTLY, SOUTH BEND MEDICAL FOUNDATION DOES NOT HAVE AN EFFECTIVE WAY TO TRACK THE UNDUPLICATED NUMBER OF PATIENTS THAT RECEIVE FREE OR REDUCED CARE AND TIME OF SERVICE DISCOUNTS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (27 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
NICOLE ANEST MD
22030405102608034680243900250821000
FRED BUSSE MD
24578605304172048530233500278214000
ALFONSO CARDENAS MD
36171505103832060220228850394505000
BLAIR CHRENKA MD
22591205107889022860336180269755000
FRANCISCO DEOGRACIAS MD
35075005104711057710228850384168000
JAMES DYER MD
23778605402839023450125570255581000
AMOBI EZENEKWE MD
23882505402730048660353330281808000
DERRICK FORCHETTI MD
2570110510360046480273560289426000
JAMES FRAIN
22506805102669045900334830265861000
LUIS GALUP MD
36184905307000060400349280409871000
NITA GERIG MD
28417905102875053160325090324930000
RICKY HOOVER MD
34598305103883058900322970388104000
KRISTEN JACOBS MD
21399605103101043550290150250518000
DIANE JANOWIAK
22684305301198041350228250255054000
DAVID JENTZ MD
36286605103883060270222400395066000
PRENTISS JONES
14685805100026350194660169010000
WILLIAM KALINEY MD
38147805106568060450238810418023000
C K KIM MD
36146905104711060270258310398089000
ROBERT KING
249364051011345048290238020289391000
JOHN LANDGRAF MD
24828605103039048530208500277079000
ODETA LAPKUS MD
2463050510540024160272340276546000
JOSEPH PRAHLOW MD
26622205102846049660294630303548000
JOYCE SIMPSON MD
2640410510509049940119080281504000
ANN SULLIVAN
22506805103641044360334830266679000
DEBORAH SUN
17309605100034780281240204749000
BOBBIE SUTTON MD
2748340540828051850192370300138000
ROBERT TOMEC MD
38349405105595062030227810418124000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Health or social club dues or initiation feesSchedule J, Part I, Line 1aTHE ORGANIZATION INCLUDES THE PERSONAL USE OF SOCIAL CLUB DUES IN TAXABLE COMPENSATION FOR THE ORGANIZATION'S VICE PRESIDENT OF FINANCE AND VICE PRESIDENT OF CENTRAL LAB OPERATIONS. PERSONAL USE IS DETERMINED BY SIGNED ACKNOWLEDGEMENT OF EACH OFFICER.
Supplemental nonqualified retirement planSchedule J, Part I, Line 4bTHE ORGANIZATION HAS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN THAT WAS DESIGNED TO REPLACE RETIREMENT BENEFITS LOST BY INDIVIDUALS DUE TO 1998 CHANGES IN PENSION LAWS AND A REDESIGN OF THE PENSION PLAN TO MAXIMIZE BENEFITS FOR LOWER COMPENSATED EMPLOYEES. THE ORGANIZATION'S BOARD OF DIRECTORS ELECTED TO FREEZE THIS PLAN, AND THEREFORE NO BENEFITS WERE PROVIDED DURING 2011.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
MICHIANA HEALTH INFORMATION NETWORK LLC (MHIN)
R. TOMEC AND R. KING, SBMF OFFICERS, ARE MHIN BOARD MEMBERS.696000SBMF OWNS AN INTEREST IN MHIN, A JOINT VENTURE THAT MAINTAINS A COMMUNITY-BASED MEDICAL INFORMATION SYSTEM AND CLINICAL DATA DEPOSITORY. SBMF PURCHASED SERVICES AT FMV FROM MHIN DURING 2011.false
COMMUNITY OCCUPATIONAL MEDICINE (COM)
D.VAN RYN, A PARTIAL YEAR SBMF BOARD MEMBER, IS A BOARD MEMBER AND PARTIAL OWNER OF COM.144061COM REFERS LAB TESTING TO SBMF, WHICH IS BILLED THROUGH A 3RD PARTY INSURANCE PROVIDERfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Delegate broad authority to a committeeForm 990, Part VI, Section A, Line 1aTHE ADMINISTRATIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE CORPORATION. SUBJECT TO THE CONTROL OF THE BOARD OF DIRECTORS, THE ADMINISTRATIVE COMMITTEE SHALL HAVE FULL AUTHORITY TO ACT FOR AND ON BEHALF OF THE CORPORATION AND EXERCISE ALL OF THE POWERS OF THE BOARD OF DIRECTORS THAT MAY BE LAWFULLY DELEGATED BY SUCH BOARD TO SUCH COMMITTEE EXCEPT, HOWEVER, THE ADMINISTRATIVE COMMITTEE SHALL HAVE NO POWER TO DONATE ANY PART OF THE ASSETS OF THE CORPORATION. THE ADMINISTRATIVE COMMITTEE SHALL RECEIVE STATUS REPORTS ON OTHER COMMITTEE ACTIVITIES AND DISCUSS ITEMS OF INTEREST TO THE GROUP AS A WHOLE OR TO INDIVIDUAL OFFICERS FOR THE PERFORMANCE OF THEIR DUTIES. THE ADMINISTRATIVE COMMITTEE SHALL KEEP MINUTES OF ITS MEETINGS.
Family/business relationships amongst interested personsForm 990, Part VI, Section A, Line 2BOB SUTTON (HUSBAND OF BOBBIE SUTTON) AND FRED BUSSE - BUSINESS RELATIONSHIP, ANA CARDENAS (WIFE OF ALFONSO CARDENAS) AND JOHN JACOBS (HUSBAND OF KRISTEN JACOBS) - BUSINESS RELATIONSHIP, DAVID VAN RYN AND JOHN RICE - BUSINESS RELATIONSHIP
Review of form 990 by governing bodyForm 990, Part VI, Section B, Line 11bPRIOR TO NOVEMBER 15, 2012, EACH BOARD MEMBER WAS PROVIDED A COPY OF THE RETURN FOR THEIR REVIEW AND INSTRUCTED TO SUBMIT ANY QUESTIONS OR COMMENTS TO THE VP OF FINANCE. AFTER COMMENTS AND QUESTIONS ARE REVIEWED, THE RETURN WAS COMPLETED AND FILED WITH THE IRS ON OR BEFORE NOVEMBER 15, 2012.
Conflict of interest policyForm 990, Part VI, Section B, Line 12cANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE COMPLETED BY ALL BOARD MEMBERS, OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES. THE ORGANIZATION'S VICE PRESIDENT OF FINANCE AND TAX ADVISERS REVIEW ALL RESPONSES TO DETERMINE WHETHER OR NOT A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS. IF AN ACTUAL CONFLICT OF INTEREST IS DETERMINED TO EXIST, PERSONS WITH A CONFLICT ARE RECUSED FROM VOTING ON THE CONFLICTING ISSUE.
Process used to establish compensation of top management officialForm 990, Part VI, Section B, Line 15aON AN ANNUAL BASIS, THE ORGANIZATION'S COMPENSATION COMMITTEE REVIEWS AND APPROVES COMPENSATION FOR THE PRESIDENT/EXECUTIVE VICE PRESIDENT, AS WELL AS OTHER OFFICERS, ADMINISTRATORS, AND PROFESSIONAL STAFF, INCLUDING KEY EMPLOYEES. THE COMMITTEE REVIEWS CURRENT SALARIES AND PAY STRUCTURES AGAINST VARIOUS SOURCES OF COMPARABILITY DATA, INCLUDING: THE COLLEGE OF AMERICAN PATHOLOGY PATHOLOGISTS COMPENSATION SURVEY; PATHOLOGY COMPENSATION DATA FOR PATHOLOGISTS, WHICH OUTLINES PATHOLOGY AND PHYSICIAN SALARIES BY SPECIALTY, PROVIDED FROM MERRITT HAWKINS AND ASSOCIATES; THE GUIDESTAR NATIONAL COMPENSATION REPORT; AND COMPENSATION REPORTED ON LOCAL AREA HOSPITALS' FORMS 990. AFTER REVIEWING THE COMPARABILITY DATA, THE COMMITTEE DISCUSSES THE CURRENT ECONOMY AND FINANCIAL POSITION OF THE ORGANIZATION TO DETERMINE THE AMOUNT OF ANY COMPENSATION INCREASES AND/OR DECREASES, IF ANY, THAT WILL BE GIVEN. THIS PROCESS IS DOCUMENTED IN THE COMPENSATION COMMITTEE'S MEETING MINUTES. THE COMPENSATION REVIEW COMMITTEE MET APRIL 26, 2011 AND REPORTED AT THE MAY BOARD OF DIRECTOR'S MEETING.
Process used to establish compensation of other officers/key employeesForm 990, Part VI, Section B, Line 15bSEE NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A.
Governing documents, conflict of interest policy and financial statements available to the publicForm 990, Part VI, Section C, Line 19WHEN REQUESTS FOR THE ORGANIZATION'S FINANCIAL STATEMENTS ARE MADE, THE DATA IS PROVIDED ON SITE. WHEN REQUESTS FOR THE ORGANIZATION'S GOVERNING DOCUMENTS ARE MADE, THE PERSON IS REFERRED TO WWW.IRS.GOV, WHERE COPIES ARE AVAILABLE. THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC ON SITE.
Other changes in net assets or fund balancesForm 990, Part XI, Line 5NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -97912; PENSION AND POSTRETIREMENT BENEFIT - RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST - -10836707;